Provider Demographics
NPI:1245761790
Name:SANTIAGO, LAUREL (MS NUTRITION, CNS)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:MS NUTRITION, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 ELM ST
Mailing Address - Street 2:SUITE #3
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-8802
Mailing Address - Country:US
Mailing Address - Phone:973-723-3468
Mailing Address - Fax:
Practice Address - Street 1:24 ELM ST
Practice Address - Street 2:SUITE #3
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-8802
Practice Address - Country:US
Practice Address - Phone:973-723-3468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist